Frequency, Urge and Nocturia

The Overactive Bladder Syndrome

About frequency, urge and nocturia - overactive bladder syndrome

Frequency and Urge incontinence are the second most common bladder control complaint after stress incontinence. Women experience frequency and urge incontinence in higher numbers than men. Frequency is when you believe you visit the toilet too many times. The International Continence Society defines frequency as going to the toilet more than you believe is normal. Urge incontinence occurs when your bladder contracts without you intentionally wanting it to, leaving you little or no time to get to the bathroom. The symptom combination of frequency, urge and nocturia (being woken up at night to urinate) that do not have any medical reason for their occurrence is known as Overactive Bladder Syndrome (OAB).

The strong feeling to pass urine is known as an urge. It results when your bladder tells your brain that it is full, even when it is not. Normally a person’s bladder will give your brain a couple of warning messages, the first message telling you to consider finding a toilet soon. A little time later a second message is sent, telling you to empty your bladder immediately. This urgent call to empty your bladder is also accompanied by your bladder contracting. Having strong pelvic floor muscles will assist you to reduce this urgency and hold the urine in the bladder until you get to a toilet. Some people with urgency can use their pelvic floor muscle well and remain dry while other people with weaker pelvic floor muscle control experience urine loss.

What causes strong feelings of urgency in OAB?

Urge incontinence is often caused by an underlying neurological (nerve) condition that disrupts the messages between the brain and bladder. Strong feelings of bladder fullness can also be caused by bladder infections, constipation or stem from long-standing poor toileting habits, “going just in case”. People in older age groups are also known to experience higher rates of urge incontinence. In some cases, the cause of urge incontinence may not be known.

Common conditions that cause strong symptoms of urge are:

UTI’s (urinary tract infections)

Constipation

Enlarged prostate

Parkinson's disease

Alzheimer’s disease

A stroke or other brain injury

Multiple sclerosis

Urge incontinence is caused by bladder spasms, which create the feeling of urgency. These bladder spams can also disturb your sleep, multiple times over-night, this is known as nocturia. Most people with urge incontinence also report that the amount of urine they leak is much larger volumes than what is usually reported by people with stress incontinence. Feelings of urgency are also a key symptom of Overactive Bladder Syndrome or unstable bladder.

Urge incontinence is usually not accompanied by any burning sensation or an unusual urine odour when you urinate. If at any time, you notice these symptoms there is a good chance that you have a urinary tract infection. In this case, you should always seek advice from your GP.

Urge, Frequency and Nocturia - OAB Treatment

Just because you suffer from urge or OAB incontinence doesn’t mean that you should restrict your daily activities or social life. Urge incontinence responds well to the right incontinence treatment .

What treatment option you choose for your urge incontinence will normally depend on the underlying cause affecting you. As urge incontinence is normally a result of another underlying condition, that condition needs to be correctly identified so that you can be treated appropriately. Once you know the cause, your doctor will usually start by treating your urge incontinence condition using treatment options that are appropriate for you. The most common forms of conservative management are simple lifestyle changes, pelvic floor exercises and bladder retraining. The doctor may also consider prescribing an anticholinergic medication if they feel you have need.

If your urge or OAB incontinence is left untreated and unresolved, it can greatly affect the your social, professional and sex life, so it’s best to get treatment sooner rather than later.

Here are the most commonly used urge or OAB incontinence treatment techniques, exercises and tips:

Pelvic floor exercises:These exercises help strengthen the muscles that support the bladder and urethra. In many circumstances by strengthening and using this group of muscles you can reduce those troublesome feelings of urgency and confidently get to the toilet. You can identify how strong your pelvic floor muscles are next time you go to the toilet by stopping the flow of urine, mid-flow. Don’t do this too often, use this method once each week to check that the strength of your pelvic floor is improving with your exercises over time.

Bladder training: This widely used technique strengthens and enhances the bladder’s ability to hold more urine and stop it from being ‘over-reactive. The aim of bladder training is to gradually increase the amount of time between your visits to the bathroom and to reduce the risk of you falling or tripping as you rush. It is important that you consult with your doctor, a continence physiotherapist or nurse advisor to check that you can fully empty your bladder each time you pass urine before you attempt to start bladder training.

Lifestyle changes: There are several things you can change in your everyday life to lessen the severity of urge incontinence. These changes are:

Make the route to your toilet as easy and uncluttered. This way you will not trip and fall if you are rushing or the toilet access is dark during the night.

Avoid drinking fizzy and other caffeine rich drinks as much as possible. Caffeine is a diuretic and has bladder irritant properties, which means it may increase your bladder spasms and increase the amount of urine you pass.

Although this might seem counter-intuitive, don’t cut down on the amount of non-caffeinated liquid your drink. If you do this, your small urine volumes will make your bladder less likely to hold good amounts of urine. Drinking less will also increase the likelihood of you becoming constipated.

Avoid becoming constipated as a full rectum will increase your bladder spams.

Try only going to the toilet when you need to. If you go too often your bladder may become used to holding less urine.

Being overweight may increase the severity of urge incontinence. If you can, lose some weight by keeping fit and active and eating a healthy, balanced diet.

Medication used to treat urge incontinence: A group of medicines called anticholinergics have been found to be effective in combating urge incontinence. These medications block certain nerve impulses, which in turn relax the bladder. Normally medication is used in conjunction with all the other remedies listed here. Your Doctor or Continence Nurse Practitioner will ensure these medicines are right for you and are the only health professionals that can prescribe these drugs.

Surgery: Surgicallly placed nerve stimulators can be effective in treating intractable urge incontinence. Surgically placed Sacral or Tibial nerve stimulation devices are known to reduce the activity of the bladder. In most cases, surgery is only considered when all other incontinence treatment options have failed.

Products: Depend has a wide variety of incontinence products to help you maintain your confidence as you manage your urge incontinence.

Recent studies put the number of people worldwide suffering from urge incontinence at between 50 and 100 million. So, remember you aren’t alone. Urge incontinence can cause a great amount of lifestyle stress and disruption. Don’t see urge incontinence as an inevitable part of your life, fight back and regain control over your bladder. Use the advice given here and seek help, advice and support from your doctors, nurses and physiotherapist’s. They are well versed in these afore-mentioned treatment techniques and they will help you gain a real improvement in your quality of life.

Kimberly-Clark Australia makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional medical or other health professional advice.

Other types of incontinence

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